Docs Need More Incentives to Engage Patients

WASHINGTON -- As evidence accumulates that more engaged patients have better outcomes, more resources need to be invested in getting physicians and healthcare systems to increase patients' involvement in decisions about their care, advocates said here.

Although some continuing medical education (CME) is already available for physicians who are learning about ways to increase their patient engagement and communication skills, more doctors should be taking advantage of it, suggested Sherrie Kaplan, PhD, from the University of California Irvine's Health Policy Research Institute. She also recommended offering patients some sort of official training and certification in patient engagement, whereby they can receive lower premiums as an incentive if they complete it.

Monday's IOM workshop follows a report last month that found Americans live sicker lives and die younger than those in other countries. The workshop is the first in a series that hopes to spotlight what can be done to increase knowledge and research on how to improve the nation's health.

Some IOM panel members acknowledged the need to change the physician culture and convince doctors to accept a greater dialogue with patients, and a representative of GroupHealth, a health plan in Seattle, described his plan's successful patient engagement initiative.

The provider organization, which serves 600,000 Washington residents, undertook a multi-pronged program that included offering patient education on joint-replacement surgeries and alternatives. They offered a half-day CME opportunity on how to discuss options with patients and emphasized to physicians that this was a patient safety issue.

Several panel members, including Kaplan, noted doctors aren't incentivized to allow patients to ask questions or take a greater role in their care. A day-long workshop hosted by Health Affairs earlier this month included comments from many participants that pay models need to be developed to reward doctors for helping patients take a greater role in planning their care.

Jonathan Welch, MD, instructor in medicine at the Harvard Medical School and an emergency physician at Brigham and Women's Hospital in Boston, said providers need to find better ways to listen to patients and their families. He said the healthcare sector, unlike other service industries, doesn't listen well to feedback from its consumers.

Welch mentioned sharing patients' medical records as a way to engage patients. A survey published in the Oct. 2 issue of the Annals of Internal Medicine found that among more than 5,000 patients who were able to view their doctor's notes, medication adherence increased from 60% to 78%, while between 1% and 8% reported the notes caused confusion, worry, or offense.

Other advice offered to physicians and other providers during the IOM workshop included:

Teach patients how to obtain and use their personal health information

Teach consumers how to navigate the health system effectively

Present patients with options and listen to their concerns and feedback

Establish a connection and relationship with patients and their caregivers

Don't use jargon when presenting information to patients and caregivers

Find new ways to listen to patients and their families

Above all, patients want a regular, personal doctor, someone who they can go to and feel cared for and receive continuous care, according to Gary Langer of Langer Research Associates.

He pointed to a survey by the Blue Shield of California Foundation that initially found 47% of patients wanted to be part of their decision-making. After being presented with information on options for their care, that number jumped to 81%.

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